CLEVELAND — Mental health caregivers are breathing a little bit easier after a threat of collecting big money from them has been dropped. You gave us tips about this story, and we are following through with insurance organization CareSource, which is now saying it will not ask for 15% of claims paid to some caregivers.
For the co-owner of New Care Behavioral Health in Wellington, the change is good for caregivers and especially for patients.
"It takes away that extra barrier for them,” said Sarah Papesh. “It takes away that fear, that threat of these services being pulled away.”
We did a recent story with Papesh and Morgan Murray from Strive CLE Counseling in Westlake, who were concerned about the potential tens of thousands of dollars CareSource was asking for.
"These practices that have large amounts of CareSource clients, that adds up very quickly,” said Murray.
CareSource would not go on-camera but said in a statement that canceling the clawbacks “was a difficult decision,” but it wants people to have “high-quality behavioral health care.”
That decision came on the same day as a special rally of mental health providers in front of CareSource’s headquarters in Dayton.
"We advocated, and we got this immediate threat managed,” said a rally speaker at the time. “But what does this mean for the future?”
It’s a good question because CareSource also told us that from this point forward, reimbursements will be 85% and not the previous 100% for some practitioners like Papesh and Murray.
"That is something that we don’t know if we can absorb that long-term either,” said Papesh.
"Sure, the recoupments are done, but we’re also now getting paid less,” said Murray. “So, that’s still a financial hit for many providers.”
Caresource said behavioral health costs are rising, but it still wants to “ensure access to critical services for Ohioans.”
The women told us that because of the back-and-forth with CareSource and some lingering uncertainty, they have to stay on top of this.
"The mental health community still intends to continue to push back and get answers that we still don’t have right now,” said Murray.
"And that we are fighting for the mental health, the substance use treatments, the support that Ohio needs,” said Papesh.
The women said they feel the rally and news stories about the original clawbacks helped change the minds of CareSource leaders.
As a side note, we heard the concerns you had about the recoupments, and we did these stories. So, if you want the News 5 Investigators to look into your concerns, email InvestigatorTips@WEWS.com or call our tip line at 216-431-HELP (4357).
CareSource Statements:
“At CareSource, we believe everyone deserves access to compassionate, high‑quality behavioral health care, and we value the providers in our network who make that care possible for our members.
Earlier this month we notified some behavioral health providers in our network that CareSource had inadvertently overpaid them and would be implementing the correct rates consistent with the terms of their contracts, both retrospectively and for future claims. This action did not represent a rate reduction.
After direct conversations with providers over the past several days, CareSource has decided to suspend the recoupment of those overpayments. The providers we spoke to shared that the recoupment would create significant financial strain and could impact access to care for members. That feedback directly informed our decision and the individual providers impacted by this change have been notified.
Future claims will be paid at the correct rate based on the terms of our provider agreements, which apply rates in specific circumstances based on service, provider type and clinical setting. Applicable behavioral services rendered by a licensed or supervised practitioner are reimbursed at 85% of the established Medicaid fee schedule in most cases.
As behavioral health costs continue to rise, CareSource is committed to working with Ohio’s healthcare community to advance a high-quality and sustainable behavioral healthcare system. We look forward to collaborating with the state, providers and other health care partners to ensure access to critical services for Ohioans.”
After News 5 Investigators asked if the suspension of the clawbacks was temporary:
“We have no plans to re-implement the recoupments related to the overpayments that were made to licensed or supervised practitioner type providers. This was a difficult decision, and we are focused on working together to build a sustainable and high-quality behavior healthcare system as costs continue to rise.”
